An increasing number of insurance companies and managed-care organizations are covering complementary and alternative medicine, fueled by consumer demand and a growing body of scientific evidence demonstrating the benefits and cost-effectiveness.
A recent survey of 18 major HMOs and insurance providers, including Aetna, Medicare, Prudential, and Kaiser Permanente, found that 14 of them covered at least 11 of 34 alternative therapies.
Chiropractic, massage therapy and acupuncture are the three most-covered therapies followed by naturopathic medicine. Other therapies that are increasingly being included are herbal remedies, homeopathy, mind-body stress management, and meditation.
But the extent of coverage is still quite limited; people typically pay for services on a discounted fee-for-service basis or are allowed an unrealistically small number of sessions.
The end result is that the treatments are wrongly judged as being ineffective when the real problem is that the limited coverage didn't allow the person to complete the recommended treatment plan.
Here are answers to the 12 most common questions about insurance coverage for complementary and alternative medicine.
1. How do people pay for complementary and alternative therapies?
Most people pay for complementary and alternative medicine services and products themselves. An increasing number of health plans offer some coverage of complementary and alternative medicine, however it tends to be limited and varies from state to state.
2. How can I find out if there are any laws in my state about insurance coverage of a therapy I'm interested in?
You can try contacting the national professional association for that type of therapy, for example, associations for acupuncturists. Many of these associations monitor the insurance coverage and reimbursement for their specialty.
3. I have health insurance. If I am interested in obtaining treatment from a practitioner, what financial questions should I ask?
First, you need to be informed about your health insurance plan. Does it offer any coverage of complementary and alternative medicine treatments? If so, what are the requirements and limits? For example, does the plan limit the conditions it will cover, require complementary and alternative medicine services be delivered by specific practitioners (such as a licensed medical doctor or practitioners in the company's network), or cover only services if that plan determines to be medically necessary? Read your plan carefully, including the limits and exclusions. It's a good idea to check with the insurance company before you seek treatment.
Here are some questions to ask you insurer:
- Does this care need to be pre-authorized or pre-approved?
- Do I need a referral from my primary care provider?
- What services, tests, or other costs will be covered?
- How many visits are covered and over what period of time (for example, 6-10 visits a year of acupuncture)?
- Is there a co-payment?
- Will the therapy be covered for any condition or only for certain conditions?
- Will any additional costs be covered, such as lab tests, dietary supplements, equipment, or supplies?
- Will I need to see a practitioner in your network? If so, can you provide me with a list of practitioners in my area?
- If I use a practitioner who is not part of your network, do you provide any coverage? Are there any additional out-of-pocket costs?
- Are there any dollar or calendar limits to my coverage?
If the insurance company requires you to have a referral, be sure to obtain it and take it with you to the practitioner. It's a good idea to keep a copy for your own records.
4. What financial questions should I ask the practitioner?
Here are some questions to ask the practitioner or his or her office staff:
- Do you accept my health insurance?
- Do I file claim forms, or do you (the provider) take care of that?
- What is the cost for an initial appointment?
- How many treatments will I need?
- Can I receive treatment for a trial period to see if the therapy works for me before I commit to a full course?
- Will there be any additional costs?